Struggling Maine EMS Seeks 'Essential' Designation

Portland Press Herald, Maine

Rural ambulance services in Maine are buckling under a staffing and cost crisis that has been building for nearly a decade, and leaders in the field are turning to legislators and state government for help.

The state's Board of Emergency Medical Services this month put its support behind a bill to address some of the gaping holes in the patchwork system that serves Maine emergency rooms and moves patients between hospitals and health care facilities.

The bill, which is still being drafted and will be taken up in the second legislative session, in January, was sponsored by Rep. Rachel Talbot Ross, D-Portland, and would classify EMS agencies as essential services, potentially unlocking more federal funding for small ambulance providers in Maine.

In an interview Tuesday, Talbot Ross said she also intends to create a statewide working group to assess Maine's EMS needs and make long-term plans for how to repair and maintain ambulance services in rural communities. She was alerted to the crisis by an EMT in Indian Township who approached her and pleaded for help, describing the long hours and low pay for workers, and the broken funding model that is felt most acutely in the state's rural areas.

"We must finally recognize that EMS is not just an aspect of public safety but an integral part of our health care delivery system in Maine," Talbot Ross said. "We need to acknowledge that we are in the midst of a crisis and cannot wait any longer to act. This was an emergency pre-COVID, and we have not been paying attention."

Maine's network of EMS providers is a combination of publicly funded services often run by fire departments in more populated areas, and private companies that form agreements to respond to 911 calls in towns too small to run their own.

Talbot Ross said that declaring EMS services essential would be a way to open up federal resources to existing ambulance services that need help, not another unfunded mandate for small towns. She said she also plans to convene a working group of stakeholders to study how to best provide EMS services in the future, and how to attract and retain new EMTs and paramedics and pay for quality care, even in remote communities.

Struggling for Years

The state's EMS system has been struggling for years. In December 2019, the Portland Press Herald/Maine Sunday Telegram published a two-part series detailing the long, steady decline of EMS capacity throughout the state. The series traced the myriad forces responsible for the decline, including a lagging reimbursement rate from MaineCare and Medicaid, low pay for frontline workers, high operating costs for providers, and Byzantine layers of state and federal regulations.

A few months later, the pandemic shut down businesses, schools and government, and legislators have never addressed the problems the series uncovered.

Maine has lost nearly 1,500 EMTs and paramedics since 2003, more than a fifth of the workforce, according to Maine EMS, the agency that tracks and licenses EMTs and paramedics statewide. Meanwhile, the average number of EMS calls each month continues to rise — with more than 22,000 so far this year, up from about 19,900 in 2020, 21,700 in 2019 and 19,500 in 2018.

Many EMTs and paramedics are aging out of the system, said Bill Jarvis, chief of the Jackman Moose River Fire Department on the Quebec border, which has one ambulance and a volunteer crew of about half a dozen, most in their 50s or 60s. In the last four years, he said, two local classes of EMTs produced only three new EMTs. Over the same period, he lost five who left the service or retired. Pay is minimum wage, $12.15 an hour, but doubles when EMTs are on a call.

"For years, we saw this slowly coming," Jarvis said. "I think the pandemic sped it up a little bit."

Although Maine is the only state to reimburse ambulance services at 85 percent for both MaineCare and Medicaid patients, the remaining 15 percent gap is often picked up by taxpayers, said Rick Petrie, a 40-year EMS professional and chief operations officer for North East Mobile Health Services, which serves coastal communities from Rockport to Sanford.

Petrie said an update to the federal reimbursement rate by Medicare officials is still four or five years away, meaning the state must take measures between now and then to shore up the system.

Exacerbated by COVID

The pandemic has made things worse, driving out more staffers who could not sustain holding multiple jobs — a common practice for EMTs and paramedics — or did not want to get vaccinated as part of a mandate for health care workers in Maine, said Brent Libby, chief of the Windham Fire Rescue Department and chair of the state EMS board.

The board threw its support behind Talbot Ross's bill in a unanimous declaration published this week.
It also urged lawmakers to examine county government as a possible avenue for shoring up local services, but there were no details about how that might work.

Petrie said things could get much worse if the state does not act, and some towns are already feeling the pain.

When a two-car crash injured five people on Mount Desert Island last month, for instance, the island's three EMS providers could muster only one ambulance, and first responders had to call in a LifeFlight helicopter and two ambulances an hour away in Bangor.

In another case, Petrie said a child being treated at Maine Medical Center in Portland had to wait four hours before hospital staff could find an ambulance available for transport to a Boston facility. Staff eventually had to summon an ambulance from Massachusetts.

Petrie said he spoke with a doctor in Augusta who recently considered driving a patient to another facility herself when there were no ambulances to be found.

"You have these EMS providers in the background — EMTs, firefighters carrying the weight of the EMS system on their backs," he said. "I am worried about their resilience. The drain on the providers is terrible."